title: Depression, anxiety and loss of resilience after multiple traumas: an illustration of a mediated moderation model of sensitization in a group of children who survived the Nazi Holocaust.
abstract: BACKGROUND
  Depressive and anxiety disorders (DAD) have become a major public health problem. Multiple trauma is known to increase the risk of DAD through a sensitization mechanism. We investigate the hypothesis that resilience is a mediator of this mechanism.
  
  
  METHODS
  Former Hidden Children (FHC), the Jewish youths who spent World War II in various hideaway shelters across Nazi-occupied Europe, were compared with a control group. In each group, we measured the presence of multiple traumas, the resilience with the Resilience Scale for Adults, which has a six factors solution, and the DAD with the Hopkins Symptoms Checklist. We test a mediated moderation model with childhood trauma as the predictor; Later trauma as the moderator; Resilience as the mediator; and DAD as the outcome variable.
  
  
  RESULTS
  Results are consistent with a sensitization model of DAD mediated by resilience: confrontation with a primary trauma during childhood followed by secondary trauma(s) after childhood damages resilience, which, in turn, results in higher level of DAD.
  
  
  CONCLUSIONS
  We are unable to differentiate if the sensitization process is a consequence of the nature of the trauma endured by FHC (long-standing exposure to extreme external events) or a consequence of the fact that this first trauma occurred during childhood.
  
  
  CONCLUSIONS
  Resilience construct is multi-factorial and a limited damaging of some of the factors is sufficient to lead to DAD even if other factors remain unaltered. Resilience can be altered by multiple traumas and, therefore, needs to be bolstered in therapy sessions.
authors.affiliation: Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fossion
authors.forename: Christophe
authors.initials: C
authors.lastname: Leys
authors.forename: Chantal
authors.initials: C
authors.lastname: Kempenaers
authors.forename: Stephanie
authors.initials: S
authors.lastname: Braun
authors.forename: Paul
authors.initials: P
authors.lastname: Verbanck
authors.forename: Paul
authors.initials: P
authors.lastname: Linkowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000209:etiology / Q000523:psychology*; D057189:Checklist; D002648:Child; D003863:Depression / Q000209:etiology / Q000523:psychology; D005060:Europe; D005260:Female; D049673:History, 20th Century; D017767:Holocaust / Q000266:history / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008297:Male; D008960:Models, Psychological; D011581:Psychological Tests; D055500:Resilience, Psychological; D040921:Stress Disorders, Traumatic / Q000209:etiology / Q000523:psychology*; D047789:World War II
keywords: Holocaust; Older adults; Resilience; Trauma